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Doctors at St. Mike's launch project to address root causes of poor health

Do health and wealth go together? Doctors at St Michael's hospital think so and have launched an innovative project to address the root causes of poor health

Dr. Gary Bloch, Karen Tomlinson, and Dr. Andrew Pinto are part of an innovative project at St. Michael's hospital in Toronto to prescribe patients income security, after seeing the negative impact of poverty, financial stress, and precarious work at their inner city family health clinic. (Sara Mojtehedzadeh / TORONTO STAR)

Melissa Hudson, who is transgendered, was a patient at St Michael's hospital who benefitted from an in-house program to assist patients on low incomes with their finances. (Andrew Francis Wallace / Toronto Star)

Any patient hopes a doctor’s appointment will help them get back to feeling like a million bucks. Few expect to leave with real money in the bank.

But that’s exactly what an innovative project at St. Michael’s Hospital in downtown Toronto is trying to do.

It’s based on compelling evidence that health and wealth go together. Studies show that illnesses such as diabetes are twice as common in Ontario’s poorest households. Cardiovascular disease is 17 per cent higher than the national average for low-income Canadians. Cancer, arthritis, and asthma are all more common amongst the poor.

Research suggests that chronic stress, often caused by financial strain, can even impact our very biology.

Now, a team of family health doctors is taking action — in a program that Dr. Gary Bloch says is possibly the first of its kind in North America.

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Launching his career at St. Mike’s roughly a decade ago, Bloch witnessed first hand the crippling effects of poverty on the body. He soon realized medical interventions often weren’t enough to treat many of those at his inner city clinic. Yet traditionally, doctors saw the social and economic currents buffeting their patients’ live as beyond their remit.

“That’s the piece that I really wanted to challenge,” he says.

“We had this kind of crazy idea: Why not propose to (the Ministry of Health) a position within these teams focused on what we see as a base determinant of people’s health — in this case income?” says Bloch.

In the summer of last year, the province approved Bloch’s “crazy idea.” Karen Tomlinson joined the hospital’s family health team as full time health promoter, specifically focused on improving patients’ financial situation.

Once the patient receives a prescription for income security from one of the 50 odd family health doctors at the clinic, they are booked an appointment with Tomlinson. She helps them file tax returns, figures out which benefits they are eligible for, and advises them on retraining programs that might help them land a more lucrative job.

Melissa Hudson is one beneficiary. She spent 35 years in corporate finance and had put aside a tidy sum of money to save for fully transitioning into a woman.

But her life started to unravel when her back was broken in a bike accident. She lost her job, battled homelessness and depression and was eventually hospitalized at St. Michael’s after being assaulted. She says when she first heard of the program, she was amazed.

“I just didn’t believe it. I couldn’t believe all of the things were finally lining up and I could start getting some help.”

Tomlinson helped Hudson start rebuilding her finances, including filing for bankruptcy — a process that can cost hundreds, if not thousands, of dollars.

“A big part of getting better is taking care of all the things you have to,” says Hudson. “It was just great to have somebody keep me motivated and on track. Because I would have just given up.”

Dr. Bloch says the impact of this kind of support on patients can be more dramatic than any drug.

“This just allows me to add on another health intervention to what we’re able to do as a team. It’s a necessary intervention that is just often allowed to fall by the wayside,” he says.

Some argue that addressing the root causes of illness is now more necessary than ever, as precarious work complicates Canadians’ ability to earn a living — and stay healthy.

“Quite a few of the patients that I see are working people,” says Tomlinson. “They have precarious jobs. Some people have two or three jobs … often times they’re even afraid to speak to their supervisors or HR about what their options are.”

Dr. Evelyn Forget, an economist and professor with the University of Manitoba Community Health Department, has dug up historical data showing the link between income security and health. She analyzed the impact of an abandoned experiment from the mid-1970s that gave residents of the tiny town of Dauphin a guaranteed yearly income.

Trawling through 1,800 dusty boxes of long-forgotten data, she saw that many of the recipients shared a common trait: they were in seasonal, temporary and low-wage work.

“I guess the stresses of managing those kinds of things, particularly if a breadwinner falls ill or there are other particular challenges for the family, were pretty profound,” says Forget.

In Dauphin, providing such families with a reliable income seemed to hold remarkable health benefits: the program coincided with an 8.5 per cent drop in hospital admissions. Doctors encountered fewer mental health problems. Accidents and injuries in the town declined, a sign that residents were under less pressure to work sometimes dangerous jobs when sick or fatigued.

Forget believes those lessons are just as relevant today.

“What made Dauphin sort of an anomaly at the time was that people were employed in ways that have become very typical,” she says.

The St. Michael’s initiative wants to address that reality. It is engaging with the Workers’ Action Centre, a Toronto-based community group that helps precarious workers. It has just hired a lawyer who will come work on site to provide patients with legal support where needed. And it has brought on a community engagement specialist to help understand the needs of local neighbourhoods.

The project is getting traction in the medical community too: in November of this year, it won best new idea at the Family Medicine Forum, the largest and most important gathering of family health professionals in the country.

Dr. Andrew Pinto, who is researching the impact of the project, hopes the Ontario government is taking heed.

“It fits really well with the excellent health care for all act and other initiatives the ministry has around addressing health inequities,” he argues.

“We’re not talking about building new hospitals or really expensive programs with this type of service. It’s more a reorienting of what we’re already doing.”

Minister of Health Eric Hoskins says he’s paying attention.

“I think it’s a very interesting approach that I’m going to be watching very, very closely to see what lessons we can learn from it,” he told the Star.

Hoskins, who has been a doctor himself for 25 years with a focus on public health, says he’s working hard to make tackling poverty a part of the government’s broader health strategy. It’s work the St. Mike’s family health team welcomes — and wants to see more of.

“People are really excited to see this on the ground,” says Bloch. “On the other hand, people say ... sure, you managed to get funding for this, but really, is this ever going to be broadly spread amongst health teams?

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